Individual
JASON ALAN MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
7525 MAPLECREST RD # 112, FORT WAYNE, IN 46835-1897
(260) 273-1206
Mailing address
7525 MAPLECREST RD # 112, FORT WAYNE, IN 46835-1897
(260) 273-1206
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005269A
IN
Other
Enumeration date
10/30/2016
Last updated
10/30/2016
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